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TreacherousCretin
08-15-2014, 08:01 PM
I have a simple question: What does "(after fasting) suboptimal high insulin level" mean? In layman's English. Google gives me nothing but technical jargon.
I'm asking for medical facts only, no opinions or conjectures please.

And yes, it's me. I see the Doctor Monday for the details and recommendations.

Ca3799
08-15-2014, 08:15 PM
It just means your fasting blood glucose level was high, which in 'not optimal.'

DSeid
08-15-2014, 09:07 PM
Not necessarily.

Mind my asking why your fasting insulin level was measured? I am not familiar with using that as a screening test. Usually one gets a fasting glucose or a hemoglobin A1c. Maybe even following up with an oral glucose tolerance test.

The likely explanation for an elevated fasting insulin level would be insulin resistance, hence more is needing to be pumped out even at baseline. Insulin resistance is considered the beginning of the path to Type 2 diabetes. and is also associated with other harms. Of course it also could be caused by an insulin secreting tumor (causing low blood sugars). Or given as a shot in someone with Munchhausen Syndrome ...

KarlGauss
08-15-2014, 09:33 PM
I suspect it means that although the insulin level was high, it wasn't high enough.

Backing up a bit . . . As you probably know, most people with type II diabetes are resistant to the effects of insulin. In such individuals, at least early on, their pancreas compensates for the insulin resistance by secreting enough insulin to overcome the resistance. By definition, then, their insulin levels will be high.

Eventually, in some people with insulin resistance, the pancreas begins to poop out and fails to produce enough insulin to offset the resistance. Their insulin levels will still be high, but may not be high enough to offset the insulin resistance. At that point, the blood sugar will begin to rise and then it's vicious circle time: the higher than normal blood sugar tends to be toxic to the insulin-producing cells of the pancreas and that tends to lead to a further drop in insulin levels and thus higher blood sugar, etc.

The high sugar is not only toxic to the insulin producing cells of the pancreas, but also can make the insulin resistance even worse.

The good news in all this is that lowering the blood sugar level, no matter how it's achieved, will both lessen insulin resistance and 'detoxify' the insulin-producing cells in the pancreas with the latter promoting more insulin to be secreted and thus a drop in sugar. If the person is lucky and keeps at it, this can be a vicious circle in the right direction, i.e. lower sugar => more insulin secreted and less insulin resistance ==> lower sugar (RLR).

TreacherousCretin
08-16-2014, 01:34 PM
Mind my asking why your fasting insulin level was measured? I am not familiar with using that as a screening test. Usually one gets a fasting glucose or a hemoglobin A1c. Maybe even following up with an oral glucose tolerance test.


A cluster of symptoms, and negative results from many tests, until this one. Doctor is determined to find out what's ailing me.
Thanks, all. Over and out.

Edit: I don't mean to seem ungrateful or dismissive, I really appreciate your inputs. You've all answered my question quite thoroughly. Thanks again.

DSeid
08-16-2014, 02:24 PM
Good luck! And you had not come off as either so no worries.

One thing though to be aware of (and while it might not apply to your specific circumstance it still needs pointing out as a general point), and at the risk of appearing intrusive ... order enough tests and some are bound to be abnormal just as a matter of basic statistics. Good tests will run maybe 5% false positive, 95% true positive ... on average order 20 of them and you are due for a false positive.

Again, no idea if it has any applicability to your circumstance and I have neither any need or right to know what they are ... nor any burning curiosity honestly. But it does bear mentioning when the very common "many tests" approach is mentioned. Meanwhile best of luck. Your doctor seems dedicated to helping you. Take care.

DSeid
08-16-2014, 04:31 PM
A good explanation (https://www.math.hmc.edu/funfacts/ffiles/30002.6.shtml) related to the bit I was talking about with specific reference to Bayes Theorem. Suppose that you are worried that you might have a rare disease. You decide to get tested, and suppose that the testing methods for this disease are correct 99 percent of the time (in other words, if you have the disease, it shows that you do with 99 percent probability, and if you don't have the disease, it shows that you do not with 99 percent probability). Suppose this disease is actually quite rare, occurring randomly in the general population in only one of every 10,000 people.

If your test results come back positive, what are your chances that you actually have the disease?

Do you think it is approximately: (a) .99, (b) .90, (c) .10, or (d) .01?

Surprisingly, the answer is (d), less than 1 percent chance that you have the disease!
And another (http://www.sciencebasedmedicine.org/why-doctors-order-too-many-tests/) that is pretty spot on.Too many tests can be hazardous to your health for several reasons:

Because of the way normal values are determined (testing a lot of presumably normal people and cutting off the ends of the resulting Bell curve), there is a good chance that one out of every twenty tests will give an “abnormal” result that is not really abnormal. Being 6 feet 7 inches tall falls at one extreme of the Bell curve but it is “normal” for that person and doesn’t mean he has a disease.
False positive results become increasingly likely when a disease is rare and/or when the patient’s history and physical don’t already point to that diagnosis.
Following up on false positive results can be a wild goose chase, with more unnecessary tests and procedures. There’s no way to tell for sure whether a suspicious shadow on an x-ray represents a deadly disease or a harmless artifact without invasive procedures that carry risks.
Imaging procedures and other tests frequently identify “incidentalomas,” abnormal findings that are mere curiosities and that have no impact on the patient’s health other than to sometimes cause unnecessary worry.
Some tests involve potentially harmful radiation; and even the simple act of drawing blood can cause pain, bruising, and a tiny risk of infection. Even minor risks are not justified if the likelihood of benefit is too low.
Lab errors occur: machine malfunctions, misreading results, mixing up samples, recording and transcription errors, etc.
Overdiagnosis leads to unnecessary treatments.
Tests cost money, sometimes a lot of money, which is not healthy for your own wallet or for society’s health care budgets.
Again, I am NOT stating that your test is inappropriate. I have no information to make any comment specific to your circumstance and respect that you are working with a doctor who seems to be working in your best interest with you. It is merely an opportunity to bring up something that often is underappreciated: you really do not want tests done unless there is very good cause to have them done; more tests are not better and can cause real harms.